Annual Well-woman Exams
We see women of all ages, from teens to their 80s, every day for well-woman exams. These exams are an essential part of maintaining long-term health and preventing illness before it occurs. Each visit includes a full medical history, physical exam (general, breast and pelvic), and discussion of health maintenance strategies. Appropriate mammograms, colonoscopies, and blood work (cholesterol screening) are ordered. Unfortunately, insurance companies do not allow us to address significant gynecologic problems on the same day as a well-visit, therefore these problem appointments must be scheduled as separate visits.
Abnormal bleeding, whether irregular, heavy, or absent, is a common problem for women. It can be caused by hormonal problems (low thyroid function, polycystic ovarian syndrome, diabetes), anatomic issues (uterine fibroids, polyps), blood abnormalities (von Willebrands disease), and infection (sexually-transmitted diseases). It is essential to fully evaluate the source of the problem rather than just masking the symptoms with birth-control pills, as the treatment should be directed at the true cause. We complete this evaluation in an organized, prompt manner in order to provide understanding to the woman experiencing these symptoms and to provide education to allow her to choose the treatment plan that best fits her lifestyle and beliefs.
Pelvic Pain / Endometriosis
Pelvic pain with and between menstrual cycles can impair a woman’s quality of life and ability to work or attend school. Although endometriosis is one common cause of such symptoms, other causes include fibroids, adhesions, infection, etc. Such pain is evaluated with pelvic exam, ultrasound, trial of medications, and ultimately explorative surgery. Long-term pain medications are never the ideal solution given issues of addiction and therefore, we always attempt to identify the source of the pain and treat it directly. If long-term pain medications are required, we work in conjunction with pain management specialists to find the appropriate regimen. Our ultimate goal is to relieve the pain symptoms and return each woman her quality of life.
Family Planning / Contraception
Family planning is an essential part of every woman’s life – deciding when to conceive and when to postpone pregnancy. Pre-pregnancy counseling is especially important for those women with chronic medical problems that might have complications in pregnancy that can be prevented with advanced planning. Contraceptive options are diverse today, and no longer include just birth-control pills. Now, traditional birth-control medication (combined estrogen/progesterone) can be administered through a skin patch or vaginal ring. Progesterone-only birth-control is still available in pill and injection (depo Provera), but now also in a 3-year implantable option (Nexplanon). Intra-Uterine Devices (IUD) are another long-acting contraceptive that can either contain hormone (Liletta, Mirena, Sklya) or not contain hormone (Paragard). These are placed into the uterine as a simple office procedure and can stay in place for 3-10 years depending on the IUD chosen. Permanent sterilization through tubal ligation / tying of tubes can be done immediately after childbirth, laparoscopically through telescope into the abdomen, or hysteroscopically through a telescope into the uterus (Essure). Laparoscopic tubal ligations are now done frequently with complete removal of the fallopian tubes which has been shown to reduce risk of ovarian cancer. Of course, we always encourage our patients to discuss vasectomy with their partners given that this is the simplest, lowest-risk procedure to achieve permanent sterilization.
Infertility Evaluation / Treatment
Infertility affects up to 15% of the population. Not all infertility is due to female problems – in fact, 40% has a male source, 40% has a female source, and 20% has no identifiable source. After 6 – 12 months of trying to conceive without success, we begin the evaluation with blood work, ultrasound, and hysterosalpingogram (HSG) for the female partner and semen analysis for the male partner. Based on these results, medical (metformin, clomid, etc) and surgical (laparoscopic removal of endometriosis or adhesions) treatments are initiated. If injectable medications, intrauterine insemination (IUI), or in-vitro fertilization (IVF) are necessary, we refer all patients to one of the fellowship-trained reproductive endocrinology/infertility physicians in central Texas.
Abnormal Pap Smears / Colposcopy
Most abnormal pap smears are caused by the human papilloma virus (HPV), which is a virus transmitted through sex. The Pap smear is a screening test for pre-cancers and cancers of the cervix. When a Pap smear returns abnormal, the cervix must be examined in detail using a colposcopy (microscope for the cervix) to look for these lesions. Such lesions are then biopsied to assess whether a true precancer or cancer exists. Further treatment is then based on these biopsy results – repeat pap smear in 12 months for low-grade lesions, LEEP (loop electrocautery excision procedure) for high-grade lesions, and hysterectomy for cancers. This can be a very anxiety-provoking experience, particularly given the sexual-transmission of the viral source of this problem. We schedule these appointments quickly and report results to patients as soon as they are available to reduce this anxiety.
Menopausal Care / Bioidentical Hormones
Some women gracefully enter menopause while others find this transition torturous. For those with significant symptoms, much can be done to reduce these symptoms – both with hormonal, non-hormonal, and herbal treatments. We explore all of these options with our patients and allow the individual woman to decide which treatment best suits her. Bioidentical hormones are very popular today and have there place in the treatment of these symptoms. Bioidentical hormones are available both through compounding and traditional pharmaceutical companies in tablet and cream form.